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MHD > Stuff to memorize for pulm > Flashcards

Stuff to memorize for pulm Flashcards

1
Q

Name the 4 criteria for characterizing exudates.

Hint- 1 involves total protein, 2 involve LDH, and 1 involves chol.

A

TPpl/TPserum > 0.5, or
LDHpl/LDHserum > 0.6, or
LDHpl > 200 (or 2/3 upper normal)
Cholesterolpl > 45

(last 2 are part of the “revised criteria”)

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2
Q

What criteria do you need to dx an empyema? (1 of these 3)

A

+ Gram Stain
+ Culture
Pus

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3
Q

Risk factors for obstructive sleep apnea? (7)

Risk factors for central sleep apnea? (2)

A

Obstructive Sleep Apnea:

  • Obesity
  • Neck Circumference (>17 in)
  • Hypertension
  • Male Gender
  • Increasing Age
  • Smoking
  • Retrognathia

Central Sleep Apnea

  • CHF
  • CNS Disease
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4
Q

Orange cells on PAP stain is characteristic of what cancer?

A

SQC

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5
Q

Highest frequency mutations in SQC?

A

p53

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6
Q

TTF-1 is positive in what cancer?

A

Adenocarcinoma

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7
Q

What are the 3 driver mutations of adenocarcinoma, and the specific drug that can target each?

A 
Adenocarcinoma? EAK! (pussies: girls, nonsmokers)
	E EGFR (erlotinib)
	A ALK (crizotinib)
	K KRAS (none)
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8
Q

What 2 mutations are seen in 100% of SCC cases?

A

p53 (smoking)

RB

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9
Q

How do you manage a pt w/low pressure pulmonary edema?

A

1) Fix the underlying problem
*Lower the hydrostatic pressures (even though it’s not high)
- Dry pt out, lower preload as low as CO maintained
- Oxygen (but recognize that this is shunt)
- Mechanical Ventilation
High PEEP
Low tidal volumes
- Salvage therapy- ECMO

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10
Q 
What are 2 effective treatments for pulmonary HTN?
What drug class is effective in 10% of pts?
Why should vasodilators be avoided?
A
  1. Pulmonary rehabilitation (exercise, etc).
  2. Oxygen if needed.

~10% of patients can have a response to calcium channel blockers

  • All other vasodilators cause systemic hypotension before pulmonary vasodilation.
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11
Q

Acute sinusitis is a clinical dx. What sx are present?

A

Congestion, sinus tenderness, fevers, purulent nasal drainage

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12
Q

Most incidents of acute sinusitis are viral. What abx are indicated if there is strong evidence of bacterial sinusitis?

A

Ampicillin or amoxicillin or trimethoprim-sulfamethoxazole or amoxicillin-clavulanate

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13
Q

Most incidents of acute sinusitis are viral, but when bacterial, what bacteria are most common?

A

S pneumonia, H. influenza, Moraxella and oral anaerobes

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14
Q

Why do you treat strep throat (caused by GAS/GBS)?

A

Treatment prevents the complications (rheumatic fever and post strep glomerulonephritis) but does not change the course/duration of the pharyngitis itself.

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15
Q

The most common etiologic organisms in epiglottitis are:

A

Haemophilus influenzae, Group A strep, and Haemophilus parainfluenzae

(Fortunately with immunization of infants against influenza B, epiglottis is being seen less commonly)

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16
Q

What tx’s (abx) are recommended for epiglottitis?

A

Emergent evaluation by an otolaryngologist to assess and secure the airway;
Antibiotic therapy: amoxicillin-clavulanate or ampicillin-sulbactam or 3rd generation cephalosporin

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17
Q

What are the sx of PNA?

A

Cough, sputum production, shortness of breath and fever

Elderly may p/w AMS

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18
Q

What is the #1 cause of typical CA-PNA?

What sx do pts p/w?

A

Streptococcus pneumoniae

Fever, shaking chills (it may be a single chill), RUSTY COLORED SPUTUM, SOB, and pleuritic chest pain.

(Remember S. pneumoniae appear as lancet shaped diplococci on gram stain)

19
Q

What are some insidious organisms that can cause chronic PNA?

A
  • Slow growing organisms (Mycobacterium, Nocardia, Actinomyces)
  • Endemic fungi (Histoplasmosis, Blastomycosis, Coccidiomycosis)
  • Coxiella
  • Tularemia

(an anatomic problem (obstructed airway))

20
Q

Organisms that cause typical CA-PNA?

A

Strep pneumoniae
H. influenza,
Moraxella catarrhalis
Staphylococcus aureus

21
Q

Drugs to treat typical CA-PNA?
(outpatient?)
(outpatient w/recent abx or comorbid illness?)
(Inpatient?)

A
  • Outpatient: Macrolides or doxycycline
  • Outpatient recent antibiotics or comorbid illness: Respiratory fluoroquinolone
  • Inpatient: macrolide + beta lactam

(*at least 5 days tx)

22
Q

Organisms that cause atypical CA-PNA?

A

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella

23
Q

Drugs to treat atypical CA-PNA?

A 
-Macrolide
or
-Doxycycline
or
-Respiratory fluoroquinolone
24
Q

Organisms that cause HA-PNA?

A

Gram-neg rods:

  • Klebsiella pneumoniae
  • E coli
  • Enterobacter
  • Proteus
  • Serratia
  • Pseudomonas
  • Acinetobacter

MRSA

25
Q

Drugs to treat HA-PNA?

What if MRSA is suspected?

A 
-Antipseudomonal cephalosporin
or
-Antipseudomonal carbapenem
or
-Beta lactam-beta lactamase

If MRSA suspected Vancomycin to be added

26
Q

What general types of bugs can cause aspiration PNA?

A

Mix of gram negative aerobes and anaerobes

27
Q

Drugs to treat aspiration PNA?

A

-beta lactam + beta lactamase
or
- 3rd generation cephalosporin + metronidazole

28
Q

What general types of bugs can cause abscess PNA?

A

Polymicrobial: anaerobic mouth organisms (bacteroides, fusobacterium, peptostreptococcus),
aerobic and anaerobic streptococcus
gram negative rods

29
Q

Drugs to treat abscess PNA?

A

-Piperacillin-tazobactam
or
-Clindamycin

(*Duration of therapy is prolonged (up to 4-6 weeks))

30
Q

What defines severe sepsis?

A 
Sepsis plus evidence of NEW end organ hypoperfusion:
Elevated lactate ≥ 2.1 mmol/L
AKI
       - UOP<0.5cc/kg/hr for 2 hrs
       - Cr > 2 mg/dL
Hypotension
       - SBP < 90 mmHg
       - MAP< 65 mmHg
       - SBP > 40 mmHg from baseline
Acute respiratory failure
       - Need for intubation or non-
          invasive ventilation
Coagulopathy
       - PTT > 60 sec
       - INR > 1.5
       - Platelets < 100,000
Bilirubin > 2 mg/dL

Do not include organ dysfunction that is due to chronic condition or medication

31
Q

Summarize the initial, 3 hour, 6 hour, and 1 additional thing for the mgmt of sepsis.

A
  1. Recognize sepsis
  2. Support airway; breathing
    - 3 hour bundle: cultures; serum lactate; broad spectrum abx; IVF if hypotensive or lactate >4mmol/L
    - 6 hour bundle: vasopressors if pt remains hypotensive despite fluids; repeat lactate if elevated; pt reassessment
    - Consider steroids if hypotensive despite fluids and pressors
32
Q

In obstruction, what are the parameters that indicate that an obstruction is reversible w/bronchodilator therapy? (2)

A

Bronchodilator –> ^ FEV1 ’s by 200cc AND 12%

not referring to ratio here

33
Q

Give the Goljian age ranges for the different leukemias/lymphomas.

A 
ALL = 0-14
AML = 15-39; 40-59
CLL = 60+
CML = 40-59
34
Q

What are the sx of multiple myeloma?

A

CRAB

hyperCalcemia, Renal insufficiency, Anemia, Bone lesions

35
Q

Describe the 3 phases of ARDS

A

ARDS phases

  1. Early Exudative Phase (Acute; protein-rich fluid leakage)
  2. Subacute Proliferative Phase (Organizing of hyaline membranes)
  3. Fibrotic Phase (Late)
36
Q

What are the causes of interstitial lung diseases?

A 
SHIT FACED
Sarcoid
Hypersensitivity Pneumonitis
Idiopathic Pulmonary Fibrosis/“IIP’s”
Tuberculosis
Fungal
Aspiration / Asbestosis
Connective Tissue Diseases / (Cancer)
Eosinophilic Granuloma
Drugs: Amiodarone, Nitrofurantoin, Bleomycin
37
Q

What 4 values are used to classify the different severities of asthma?

A
  • Daytime symptoms/wk
  • Nighttime symptoms/mo
  • FEV1 or PEFR
  • PEFR variability
38
Q

What is considered the major “predisposing factor” for non-TB Mycobacteria?

A

Structural lung abnormality

39
Q

What 4 criteria define systemic inflammatory response syndrome? (SIRS)

A
  • Temperature: > 38°C or < 36°C
  • RR: >20 breaths per minute or pCO2 < 32 mmHg
  • Heart rate: > 90 bpm
  • WBC count: >12,000 or <4,000 or >10% bands
40
Q

In sepsis, under what 2 circumstances would you administer IV fluids?

What is the recommended amount? (per kg)

A

Hypotensive of lactate < 4

30mL/kg

41
Q

1st choice vasopressor for sepsis?

A

NE
(2nd: epi or vasopressin)

*But these are only given in 6 hr bundle, if pt remains hypotensive despite fluids

42
Q

What are the organisms that can cause acute bronchitis?

A

Mycoplasma
S. pneumoniae
H. infuenzae
Bortadella pertussis

43
Q

What is the usual tx for acute bronchitis?

A

Supportive! (because it’s usually viral)

MHD (20 decks)

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